射频消融联合肝动脉化疗栓塞治疗肝转移癌

Radiofrequency ablation combined with transarterial chemoembolization for treating of hepatic metastases

目的评价射频消融术（RFA）联合肝动脉化疗栓塞术（TACE）对于肝转移癌的治疗效果。方法搜集2005年3月至2010年10月36例肝转移癌患者的临床资料进行分析，其中男22例，女14例；年龄42～82岁，半均（63±12）岁；肿瘤最大径1．5～12．0cm，平均（4．5±2．4）cm，其中单发转移灶29例，多发转移7例，共47个病灶。患者均为全身化疔失败或无法耐受，且无其他脏器转移证据者。术前CT扫描，对于富血供者先行TACE，术后3周内行RFA；对于乏血供者，先行RFA，术后3周内行TACE．对于多个病灶，采取分次逐一治疗。术后每个月行B超复查及肝功能、血象、肿瘤标记物检查，每3个月行腹部CT增强扫描1次。对于随访过程中肿瘤的局部残存及复发，在可能的前提下仍行RFA＋TACE治疗。根据治疗后的影像表现分为病灶完全消融组和病灶部分消融组2个亚组，完全消融组不再进行任何治疗，定期随访观察；部分消融组如无法行进一步RFA治疗，则根据患者情况定期行TACE治疗。随访终点事件为患者死亡．对所有患者的整体生仔期及两个业组的生存期采用SPSS18．0统计分析软件，Kaplan—Meier方法进行统计分析。结果RFA全部采用经皮途径在局部麻醉结合静脉基础麻醉下完成，无严重并发症发生。16例患者经过1次或多次联合治疗后达到局部病灶完全消除（病灶完全消融组）；20例患者病灶部分消除（病灶部分消融组）．随访时间10～40个月，平均（254-10）个月。死亡23例，至今存活13例。中位生存期27个月（95％可信区：24～32个月）。至观察终点1、2、3年生存率分别为91．7％（33／36例）、55．5％（20／36例）、36．1％（13／36例）。病灶完全消融组和部分消融组的3年生存率分别为75．0％（12／16例）和5．0％（1／20例），差异有统计学意义（P〈0．01）。结论RFA＋TACE可以有效控制肝转移痈患者盱内痫变的进展．延长患者生存期。争取病灶的完全消融是提高疗效的关键。

Objective To investigate the efficacy and saiety of radiofi＇equency ablation （ RFA ） combined with transarterial chemoembolization （TACE） for treating of hepatic metastasis, Methods From Mar. 2005 to Oct. 2010, 22 males and 14 females with hepatic metastasis were enrolled in this study. Mean age of the patients was 63 ＋ 12 （42--82） years. Tumor size was （4. 5 ±2.4） cm （min. 1.5 cm, max. 12.0 cm）. Totally 47 lesions were treated with single metastasis in 29 cases and muhiple ones in 7 cases. All cases were failed to chemotherapy or could not stand for the side effect of chemotherapy. Contrast enhanced CT scan was given to all patients before RFA ＋ TACE. For lesions with rich blood supply, TACE was given and then RFA. For those with poor blood supply, RFA was given first and Ihen TACE. For muhiple lesions, RFA ＋ TACE was given one by one h）r each lesion. As for follow up, ultrasound and blood check was given monthly. Enhanced CT scan was given every 3 month. For residual lesions or recurrent lesions, RFA ＋ TACE were given repeatedly. The whole patients was divided into two groups according to the image fnllow up including complete ablation group and partial ablation group. For complete ablation group, no further treatment was given. For partial ablation group, if it was not suitable for further RFA, repeated TACE was given there after. The end point of follow up was death event. Survival of the whole group and the two subgroups was analyzed statistically by Kaplan-Meier method. Results All RFA procedures was given under intravenous anesthesia and local anesthesia, no severe complication was noted. Lesions in 16 patients were completely ablated after single or multiple sections of RFA ＋ TACE. Twenty patients were in the partially ablated group. Follow up time was 25 ± 10 （10-40） months. Twenty-three patients died and 13 kept alive during the follow up time. The estimated median survival time was 27 month （95% CI： 24- 32 months）. Survival ration at 1, 2, 3 years for the whole group was 91.7% （33/36）,55.5% （20/36）, 36. 1% （13/36） for the whole group. The 3 years survival for complete and partial ablation group was 75.0% （12/16）,5.0% （1/20）, there was a significant difference between the two groups （P 〈 0. 01 ）. Conclusion For patients with hepatic metastasis, RFA ＋ TACE can effectively control the local lesion. Complete ablation is the key point for a better survival.